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Yu S, Sodhi M, Rezaeianzadeh R, Eadie B, Etminan M. Increased risk of pigmentary degeneration of the iris and pigmentary glaucoma with fluoroquinolone antibiotics. Eye (Lond) 2024:10.1038/s41433-024-03282-z. [PMID: 39069553 DOI: 10.1038/s41433-024-03282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Fluoroquinolones are popular antibiotics used for a myriad of conditions including ocular procedures. Despite numerous case reports of acute pigmentary degeneration of the iris with fluoroquinolone use, a pharmacoepidemiological study has not been performed to examine and quantify this risk. DESIGN Retrospective cohort study with a case-control analysis. PARTICIPANTS A cohort of 1,231,881 new users of oral or topical moxifloxacin, levofloxacin, and azithromycin were followed to first diagnosis of pigmentary degeneration of the iris or pigmentary glaucoma. Four controls were selected for each case using density sampling, matching on age and calendar time. METHODS Users of oral or topical moxifloxacin were compared to levofloxacin and azithromycin, a negative control drug from a separate class. MAIN OUTCOMES AND MEASURES First incidence of pigmentary degeneration of the iris or pigmentary glaucoma. RESULTS The cohort was comprised of 1,231,881 new users of topical or oral levofloxacin, moxifloxacin, or azithromycin. 542 cases of pigmentary degeneration of the iris and 460 cases of pigmentary glaucoma were identified. The incidence of iris pigmentary degeneration or pigmentary glaucoma for topical moxifloxacin was 10.2/1000 person years compared to 2.6/1000 person years for topical azithromycin. Current topical moxifloxacin users had the highest adjusted IRR for pigmentary degeneration of the iris (IRR = 6.81, [95%CI:2.00-23.18]) and pigmentary glaucoma (IRR = 4.07 [95%CI:1.42-11.62]) respectively. CONCLUSIONS The study findings suggest that patients using topical moxifloxacin may have increased risk of developing pigmentary degeneration of the iris and pigmentary glaucoma although the absolute increase was low. Future studies are needed to confirm this association.
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Affiliation(s)
- Sabrina Yu
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohit Sodhi
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Brennan Eadie
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Mahyar Etminan
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
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Cronemberger S, Vasconcelos-Santos DV, Correia de Carvalho C, Carvalho JH, Calixto J, Diniz-Filho A. Bilateral acute iris transillumination (BAIT) syndrome: Differential diagnosis based on clinical, OCT and UBM findings. Eur J Ophthalmol 2024; 34:NP22-NP26. [PMID: 37160763 DOI: 10.1177/11206721231174489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Bilateral acute iris transillumination (BAIT) is a relatively new syndrome whose etiopathogenesis is still not fully understood. It is characterized by acute bilateral onset of intense pigment dispersion in the anterior chamber, iris depigmentation with severe transillumination defects, accentuated pigment deposition in the angle, and elevated intraocular pressure (IOP). In literature, the first case was of bilateral acute iris depigmentation (BADI) reported in 2004 in a 77-year-old woman. In 2019, Perone et al. published a review about BAIT syndrome. They reported a total of 79 cases have been published up that date, mainly in Europe and especially in Turkey and Belgium. The majority of reported cases were of bilateral acute iris depigmentation (BADI). BAIT syndrome might be mainly confused with acute iridocyclitis, acute primary angle-closure (APAC) and pigment dispersion syndrome (PDS). In relation to BAIT, controversies still exist regarding the etiology being the differential diagnosis of paramount importance for adequate treatment. PURPOSE To report a case of BAIT syndrome associated to refractory glaucoma and to discuss the differential diagnosis based on clinical, OCT and UBM findings. METHODS We present a case of BAIT syndrome in which clinical, OCT and UBM findings have pointed out the similarities and, mainly the diagnosis differences with other ocular diseases. CONCLUSIONS BAIT syndrome with accentuated IOP rise must be differentiated of other ocular diseases. It requires urgent clinical therapy and/or surgical management as occurred in the present case for avoiding structural damage in OCT and visual field loss. OCT and UBM are critical for early recognition, differential diagnosis and management.
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Affiliation(s)
- Sebastião Cronemberger
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Júlia Calixto
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alberto Diniz-Filho
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Lin ML, Hall AJ. Uveitis masquerade syndromes: An approach to diagnosis. Clin Exp Ophthalmol 2024; 52:91-105. [PMID: 37997019 DOI: 10.1111/ceo.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Uveitis masquerade syndromes are a diverse group of clinical entities which mimic conventional immune-mediated uveitis due to the presence of inflammatory signs but are resistant to anti-inflammatory therapy. Misdiagnosis hinders appropriate management in these conditions and may result in poor outcomes. This review discusses commonly encountered neoplastic and non-neoplastic disease processes that masquerade as intraocular inflammation with a focus on relevant clinical features and adjunctive investigations that are helpful in reaching a correct diagnosis.
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Affiliation(s)
- Ming Lee Lin
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Gonzalez Martinez OG, Shields CL, Shields JA, Chévez-Barrios P, Walley DR, Eagle RC, Milman T. Unilateral acute iris transillumination syndrome with glaucoma and iris pigment epithelium dispersion simulating iris melanoma. Am J Ophthalmol Case Rep 2023; 32:101912. [PMID: 37680309 PMCID: PMC10481171 DOI: 10.1016/j.ajoc.2023.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To report a patient with a unilateral presentation of glaucoma, pain, and acute iris transillumination syndrome simulating iris melanoma. Observations A 53-year-old male presented with blurred vision and pain in his right eye several weeks following a respiratory sinus infection managed by oral azithromycin. Examination of the right eye was notable for elevated intraocular pressure of 46 mm Hg, an irregular mid-dilated pupil, and diffuse iris transillumination with pigmentary seeding on the iris surface, in the anterior chamber angle, and on the sclera, suspicious for diffuse iris melanoma with glaucoma and extrascleral extension. Ultrasound biomicroscopy (UBM) of the right eye revealed circumferential anterior chamber angle and trabecular meshwork involvement by an infiltrative process corresponding to the pigmented cells noted clinically, while the ciliary body was unremarkable. Following enucleation, histopathology showed extensive necrosis of the iris pigment epithelium, sphincter, and dilator muscles with melanophagic infiltration in the anterior chamber angle and episclera, mild chronic non-granulomatous iridocyclitis, and no evidence of a melanocytic neoplasm. Although immunohistochemical studies for herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, and cytomegalovirus were negative, qualitative real-time polymerase chain reaction on paraffin-embedded tissue detected HSV-1 DNA. The combined clinical, pathologic, and molecular findings were compatible with unilateral acute iris transillumination syndrome, likely HSV-1 associated. Conclusion and Importance Unilateral acute iris transillumination syndrome with diffuse iris pigment epithelial loss can simulate iris melanoma. Prompt herpes viral studies may be informative.
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Affiliation(s)
- Orlando G. Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Patricia Chévez-Barrios
- Department of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medical College, NY, USA
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Debbie Rigney Walley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Ralph C. Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Mendez Bermudez IJ, Ramirez Marquez E, Ayala Rodríguez SC, Ruiz-Justiz AJ, Rodriguez-Garcia EJ, Gonzalez M, Nieves I, Blasini M, Santos C, Oliver AL. Bilateral Acute Iris Transillumination Syndrome Following Oral Moxifloxacin Overdose. Cureus 2023; 15:e47426. [PMID: 38022122 PMCID: PMC10658970 DOI: 10.7759/cureus.47426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of bilateral acute iris transillumination (BAIT) syndrome caused by an overdose of oral moxifloxacin in a Hispanic female patient with no previous respiratory viral infection. A 56-year-old Hispanic female with no history of ocular illness was referred to our glaucoma service to manage her microcystic edema, swelling, and refractory ocular hypertension. Her ocular and systemic symptoms, including progressively worsening bilateral ocular pain, severe photophobia, blurred vision, nausea, and vomiting, started 14 days after an accidental overdose of oral moxifloxacin. Moxifloxacin had been prescribed to treat a complicated urinary tract infection. A slit-lamp examination revealed bilateral microcystic corneal edema and transillumination in the right temporal iris, both consistent with a diagnosis of BAIT syndrome. The existing literature on BAIT syndrome is scarce, and its etiology remains unclear. This case provides clinical evidence supporting moxifloxacin toxicity as a possible cause of BAIT syndrome. We emphasize the importance of conducting extensive research to define the mechanisms involved in moxifloxacin-induced BAIT syndrome and to search for other potential etiologies of this condition.
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Affiliation(s)
- Israel J Mendez Bermudez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Sofía C Ayala Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Armando J Ruiz-Justiz
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Monica Gonzalez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Ileana Nieves
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Marino Blasini
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Carmen Santos
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Armando L Oliver
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
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Gorbea Fuxench GA, Ayala Rodríguez SC, Guardiola G, Ramos F, Pappaterra-Rodríguez M, Requejo Figueroa GA, Llop SM, Santiago LA, Santos C, Oliver AL. Bilateral Acute Iris Transillumination Associated with Moxifloxacin Antibiotic Use. Ocul Immunol Inflamm 2023:1-6. [PMID: 37652695 DOI: 10.1080/09273948.2023.2246543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To describe the clinical and demographic characteristics and associated factors leading to bilateral acute iris transillumination (BAIT) syndrome. METHODS A retrospective review of patients with BAIT syndrome was performed. RESULTS Thirty-five patients with a diagnosis of BAIT were identified. The median age at presentation was 53 years; 80% of the patients were female. Twenty-six patients (74%) had recent histories of systemic antibiotic treatment. Of those with such a history, 24 patients (92%) had been receiving moxifloxacin. Two patients within our cohort were prescribed moxifloxacin prophylactically prior to a systemic surgical procedure and had no evidence of systemic illness or recent viral illness. CONCLUSIONS Our data support the notion that moxifloxacin might be associated with the onset of BAIT syndrome. Notably, within our cohort, two patients received moxifloxacin as surgical prophylaxis and subsequently developed BAIT syndrome. This could suggest a potential association between moxifloxacin and the onset of BAIT, though further studies are needed to confirm this finding.
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Affiliation(s)
- Gabriela A Gorbea Fuxench
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Sofía C Ayala Rodríguez
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Gabriel Guardiola
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Fabiola Ramos
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Mariella Pappaterra-Rodríguez
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Guillermo A Requejo Figueroa
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Stephanie M Llop
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Luis A Santiago
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Carmen Santos
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
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Gulmez Sevim D, Sener H, Evereklioglu C. Bilateral Acute Iris Transillumination and Elevated Intraocular Pressure After COVID-19 Infection. J Glaucoma 2023; 32:e56-e59. [PMID: 36946913 DOI: 10.1097/ijg.0000000000002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023]
Abstract
Bilateral acute iris transillumination (BAIT) is characterized by abundant pigment discharge into the anterior chamber. Atonic pupil and severe intraocular pressure (IOP) elevations may be observed. Generally, there is a viral upper respiratory tract infection or systemic fluoroquinolone usage before BAIT. Two cases with a recent history of coronavirus disease 2019 (COVID-19) presented with a complaint of decreased vision. Elevated IOP and iris transillumination defects were observed in both patients. Both patients were diagnosed with BAIT. Although elevated IOP was controlled with medical treatment in 1 patient, glaucoma surgery was performed in the other patient because it could not be controlled with medical treatment. As both patients received no systemic treatment for COVID-19, the pressure rise seems to be directly related to the viral infection alone through the inflammatory process. Atypical ocular presentations of COVID-19 should be kept in mind as it can have serious consequences.
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Lončarić K, Tadić R, Radmilović M, Vatavuk Z. Bilateral Acute Iris Transillumination (BAIT): A Rare Syndrome Possibly Associated with COVID-19 and Moxifloxacin Use. A Report of 2 Cases. Semin Ophthalmol 2023; 38:312-315. [PMID: 36653737 DOI: 10.1080/08820538.2023.2168491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bilateral acute iris transillumination (BAIT) is a rare clinical entity, presumed to be associated with preceding upper respiratory tract infection and/or use of certain antibiotics, marked by bilateral acute loss of iris pigment epithelium with pigment dispersion in the anterior chamber and trabecular meshwork, which can cause elevated intraocular pressure and glaucoma, and with iris transillumination and sphincter paralysis which lead to photophobia and blurry vision. We report the first two cases of BAIT in our center which both had a history of preceding COVID-19 (coronavirus disease 2019) and moxifloxacin use. With more awareness, ophthalmologists might diagnose more cases, and thus gain more information regarding the link between COVID-19 and BAIT, which might be underdiagnosed since it is rare or easily misdiagnosed as some more common diseases with similar features.
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Affiliation(s)
- Kristina Lončarić
- Department of Ophthalmology and Optometry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Rašeljka Tadić
- Department of Ophthalmology and Optometry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marin Radmilović
- Department of Ophthalmology and Optometry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology and Optometry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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da Costa DS, Gameiro Filho AR, Barbosa AL, Brasil MVM. Bilateral Acute Iris Transillumination Syndrome after Topical Moxifloxacin/Dexamethasone Initially Misdiagnosed as Uveitis: Case Report. Case Rep Ophthalmol 2023; 14:39-46. [PMID: 36747504 PMCID: PMC9898808 DOI: 10.1159/000529014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023] Open
Abstract
Bilateral acute iris transillumination (BAIT) syndrome is a rare condition of unknown etiology, characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle, with bilateral involvement in most cases. We present a case of a 46-year-old healthy woman, who developed BAIT in both eyes, following the use of topical moxifloxacin/dexamethasone for bilateral bacterial conjunctivitis, followed by a nonarteritic anterior ischemic optic neuropathy in the left eye.
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10
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Tuğal-Tutkun İ, Altan Ç. Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)-An Update. Turk J Ophthalmol 2022; 52:342-347. [PMID: 36317812 PMCID: PMC9631498 DOI: 10.4274/tjo.galenos.2022.09552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) are relatively new clinical entities characterized by acute pigment dispersion from the iris stroma or iris pigment epithelium, respectively. While BADI presents with diffuse or geographic areas of iris stromal depigmentation without transillumination, BAIT cases typically develop diffuse iris transillumination and mydriatic atonic pupils. Prolonged pigment dispersion and ocular hypertension are more common in BAIT. Although the exact etiopathogenesis is still unknown, moxifloxacin toxicity appears to be a probable/likely cause. The underlying cause of BADI or BAIT in patients who were not exposed to fluoroquinolone antibiotics remains unexplained. Systemic viral infections, including coronavirus disease 2019, may be the triggering event in several cases.
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Affiliation(s)
- İlknur Tuğal-Tutkun
- İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey,Eye Protection Foundation Bayrampaşa Eye Hospital, İstanbul, Turkey,* Address for Correspondence: İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey E-mail:
| | - Çigdem Altan
- University of Health Sciences Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
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Oraby MF, Alrashidi SA, Hagras SM. Bilateral Acute Iris Transillumination without Prior Systemic Antibiotics. J Curr Ophthalmol 2022; 34:469-473. [PMID: 37180524 PMCID: PMC10170978 DOI: 10.4103/joco.joco_93_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To describe a case of bilateral acute iris transillumination (BAIT) with no history of systemic infections or antibiotics intake before the attack. Methods This study included the review of the clinical record of the patient. Results A 29-year-old male was referred to the glaucoma clinic with presumed bilateral acute iridocyclitis with refractory glaucoma. Ophthalmic examination revealed bilateral pigment dispersion, marked iris transillumination, dense pigment deposition in the iridocorneal angle, and high intraocular pressure. The patient was diagnosed with BAIT and was followed for 5 months. Conclusion The diagnosis of BAIT can be elicited even without a prior history of systemic infection or antibiotics intake.
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Affiliation(s)
| | | | - Sherein Mahmoud Hagras
- Department of Ophthalmology, Farwaniya Hospital, Kuwait
- Address for correspondence: Sherein Mahmoud Hagras, Department of Ophthalmology, Farwaniya Hospital, Kuwait. E-mail:
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12
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Altan C, Basarir B, Bayraktar S, Tugal-Tutkun I. Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection. Ocul Immunol Inflamm 2022:1-6. [PMID: 36083696 DOI: 10.1080/09273948.2022.2103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the presenting features and outcomes in patients who developed bilateral acute iris transillumination (BAIT) or bilateral acute depigmentation of iris (BADI) following acute COVID-19 infection. METHODS Thirty two eyes of 16 patients were reviewed retrospectively. The severity of COVID-19 infection, use of antibiotics, time of onset of ocular symptoms; ocular signs, the course and surgical procedures were recorded. RESULTS 24 eyes of 12 BAIT and eight eyes of four consecutive BADI patients were included. The mean time between infection and onset of ocular symptoms was 2.5±1.1 weeks. Nine patients were treated with oral moxifloxacin for COVID-19 prior to presentation. Trabeculectomy was performed in 7 eyes (21.8%) of 5 BAIT patients; in the postoperative follow-up, IOP was controlled without medication in 6 eyes, with medication in 1 eye. CONCLUSION BADI and BAIT can also develop after COVID-19 infection. A significant proportion of BAIT patients may require glaucoma surgery.
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Affiliation(s)
- Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Serife Bayraktar
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Ophthalmology, Bayrampasa Eye Hospital, Istanbul, Turkey
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13
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Gaur S, Sindhu N, Singh DV, Bhattacharya M, Sharma A, Shinde D. COVID-19-related bilateral acute de-pigmentation of iris with ocular hypertension. Indian J Ophthalmol 2022; 70:3136-3139. [PMID: 35918989 DOI: 10.4103/ijo.ijo_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 43-year-old male patient presented with acute blurring of vision in both eyes associated with photophobia, redness, and mild pain following coronavirus disease 2019 (Covid-19) infection. Clinical examination revealed extensive pigment dusting in the corneal endothelium and the trabecular meshwork with de-pigmentation bands in the iris periphery. The patient was managed empirically with topical anti-glaucoma medications for high intra-ocular pressure. The patient was prescribed systemic antibiotics including cephalosporins and amoxicillin for respiratory symptoms. A rare condition called bilateral acute de-pigmentation of iris (BADI) was suspected after ruling out common entities, for example, viral kerato-uveitis, pigment dispersion syndrome, and Fuchs iridocyclitis. Covid-19 infection and systemic antibiotics including cephalosporins have shown to cause BADI in the literature. The patient responded well with good outcome.
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Affiliation(s)
- Sandhya Gaur
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Narottama Sindhu
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Deependra Vikram Singh
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Mainak Bhattacharya
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Ajay Sharma
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Dattatraya Shinde
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
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Yüksel M, Özdemir HB, Özdek Ş, Gürelik G. Bilateral acute Iris transillumination after COVID-19 pneumonia. Eur J Ophthalmol 2022:11206721221113428. [PMID: 35850544 PMCID: PMC9297069 DOI: 10.1177/11206721221113428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the diagnosis, treatment and follow-up of a case of bilateral acute iris transillumination (BAIT) developed after COVID-19 pneumonia. METHOD Case report. CASE A 66-year-old male patient with COVID-19 pneumonia received systemic treatments of favipiravir, prednisolone, moxifloxacin and piperacillin-tazobactam during hospitalization. The patient applied to our clinic with the complaint of blurred vision 20 days after the diagnosis of COVID-19. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.5 in the left eye. In the anterior segment examination; ciliary injection, intense pigment dispersion in the anterior chamber, pigment deposits on the lens and iris, 2-3 + cells in the anterior chamber, posterior synechia, and 360 degrees diffuse iris transillumination were observed in both eyes. The pupillary response to light was weak. Bilateral fundus examination were normal. In the anterior chamber sample; HSV, VZV, CMV and Toxoplasma PCR were negative. Bilateral acute iris transillumination (BAIT) diagnosed in the patient and topical 0.1% dexamethasone and topical 1% cyclopentolate were started. In the follow-up, visual acuity increased 1.0 in both eyes, there were no cells in the anterior chamber, and the pigment dispersion was still continuing despite a decrease. CONCLUSION BAIT, which can usually be seen after upper respiratory tract infections, can also be seen after covid 19 pneumonia and be kept in mind as a possible eye involvement in patients with COVID-19 infection.
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Affiliation(s)
- Murat Yüksel
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Hüseyin Baran Özdemir
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Şengül Özdek
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Gökhan Gürelik
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
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Ning B, Baboolal S, Gizzi C, Nolan W. A Case of Secondary Pigment Dispersion Following Laser to Cosmetically Lighten the Irises. J Glaucoma 2022; 31:133-135. [PMID: 33449587 DOI: 10.1097/ijg.0000000000001790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
Eye color is the latest physical attribute to be subject to alteration for cosmetic reasons. We report a rare case of bilateral secondary pigment dispersion following laser burns to the irises for cosmetic purposes. This case demonstrates a case of secondary pigment dispersion not previously reported in the literature to the best of our knowledge.
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Affiliation(s)
- Brigid Ning
- Moorfields Eye Hospital, NHS Trust, London, UK
| | - Sandika Baboolal
- Moorfields Eye Hospital, NHS Trust, London, UK
- University of KwaZulu, Natal, Durban, South Africa
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16
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January consultation #4. J Cataract Refract Surg 2022; 48:127-128. [PMID: 34929715 DOI: 10.1097/01.j.jcrs.0000812824.32729.cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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January consultation #7. J Cataract Refract Surg 2022; 48:129-130. [PMID: 34929718 DOI: 10.1097/01.j.jcrs.0000812836.04377.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Acute iris toxicity following bilateral gel stent implantation with mitomycin-C and intracameral moxifloxacin January consultation #1. J Cataract Refract Surg 2022; 48:125. [PMID: 34929712 DOI: 10.1097/j.jcrs.0000000000000867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 72-year-old woman with moderate primary open-angle glaucoma was referred for management of her glaucoma and photophobia. Her ocular history is significant for routine cataract surgery in both eyes 6 years prior to presentation. She was diagnosed with glaucoma 7 months prior to presentation at which time the patient underwent sequential, ab externo, open conjunctival, Xen Gel Stent (Allergan, Inc.) placement with mitomycin-C (MMC) in each eye, approximately 2 weeks apart. The history obtained directly from the surgeon revealed that MMC dosing was 0.2 mL in a concentration of 0.2 mg/mL delivered through subconjunctival injection after placement of the gel stent. Intracameral moxifloxacin was injected at the time of surgery, and moxifloxacin and Maxitrol eyedrops were used in the postoperative period. The patient noted that, approximately 1 month after each surgery, she developed significant photophobia. An outside examination noted bilateral tonic pupils and concern for early bleb failure in the left eye. 2 months after the initial gel stent placement in the left eye, she underwent a bleb revision with a McCannel suture iris cerclage in the left eye. The intraocular pressure (IOP) in both eyes remained well controlled off pressure-lowering medications; however, the tonic pupils and photophobia persisted. The patient was subsequently referred for further assessment. At presentation, the patient's corrected distance visual acuity was 20/20 in each eye. Applanation tonometry IOP was 17 mm Hg and 14 mm Hg for the right and left eyes, respectively. Pupils were tonic and irregular. The lack of pupillary response prevented testing for relative afferent pupillary defects directly or by reverse testing. Slitlamp examination of the right eye was notable for a minimally elevated superior bleb and severe iris stromal atrophy with diffuse transillumination defects. The intraocular lens (IOL) appeared well positioned in the capsular bag without signs of pseudophacodonesis (Figure 1JOURNAL/jcrs/04.03/02158034-202201000-00021/figure1/v/2021-12-20T152346Z/r/image-tiff). The left eye was notable for a diffuse superior bleb and similar iris and IOL findings to the right eye, except for 2 McCannel iris sutures in the iris stroma (Figure 2JOURNAL/jcrs/04.03/02158034-202201000-00021/figure2/v/2021-12-20T152346Z/r/image-tiff). In both eyes, the anterior chambers were deep and quiet, and there were no corneal endothelial abnormalities. Fundus examinations of both the right and left eyes were notable for glaucomatous-appearing optic nerves and otherwise healthy macula, vessels, and periphery. Gonioscopy revealed open angles in each eye with fairly marked, densely layered pigment throughout the inferior angle and trabecular meshwork. The gel stents were positioned just anteriorly to the trabecular meshwork superiorly, well away from iris tissue. Optical coherence tomography (OCT) of the nerve fiber layer (NFL) showed moderate to severe thinning inferiorly and superiorly in the right eye, with mild to moderate thinning inferiorly in the left eye (Supplemental Figure 1, http://links.lww.com/JRS/A510). Ganglion cell analysis correlated with the NFL findings (Supplemental Figure 2, http://links.lww.com/JRS/A510). Humphrey visual field testing revealed a dense superior arcuate in the right eye and moderate inferior arcuate in the left eye (Supplemental Figures 3 and 4, http://links.lww.com/JRS/A510). OCT of the macula in both eyes was unremarkable. Finally, specular microscopy showed normal endothelial density and configuration of each eye (Supplemental Figure 5, http://links.lww.com/JRS/A510). What part of the patient's ocular history would you consider relevant to the development of tonic, atrophic pupils? What additional information would you want to know to help refine your differential diagnosis? What is your preferred surgical technique when implanting the Xen Gel Stent? Please include whether ab interno or ab externo and open or closed conjunctival approach to be used and mention antifibrosis dosing and method of administration. Finally, what would be your approach for managing this patient's severe photophobia, in the setting of her moderate open-angle glaucoma?
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Stiles MC. January consultation #2. J Cataract Refract Surg 2022; 48:125-126. [PMID: 34929713 DOI: 10.1097/01.j.jcrs.0000812816.94555.1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Rivera-Valdivia N, Arteaga-Rivera K, Reyes-Guanes J, Neira-Segura N, de-la-Torre A. Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report. J Med Case Rep 2021; 15:462. [PMID: 34537056 PMCID: PMC8449864 DOI: 10.1186/s13256-021-03075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin. Case presentation A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required. Conclusions We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.
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Affiliation(s)
- Nicolás Rivera-Valdivia
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Karla Arteaga-Rivera
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Natalia Neira-Segura
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos research group, Escuela de Medicina y Ciencias de la salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
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21
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Klonner J, Salchow D. [Unusual anisocoria]. Ophthalmologe 2021; 118:597-599. [PMID: 32588124 PMCID: PMC8187173 DOI: 10.1007/s00347-020-01153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eine 53-jährige Patientin beklagte erhöhte Blendempfindlichkeit 3 Wochen nach Einnahme von Moxifloxacin-Tabletten bei Infekt der oberen Atemwege. Es bestand eine Anisokorie, die Pupillenreaktion, sowohl auf Licht als auch auf Naheinstellung, war aufgehoben. In der Untersuchung des vorderen Augenabschnittes fielen beidseits ausgeprägte Iristransilluminationsdefekte (ITD) auf. Wir diagnostizierten ein BAIT-Syndrom (bilaterales akutes Iristransilluminationssyndrom). Dies ist ein seltenes Syndrom, welches mit einer massiven Depigmentierung der Iris sowie einer Atrophie der Irismuskulatur einhergeht. Risikofaktor für die Entstehung eines BAIT-Syndroms scheint die orale Einnahme von Antibiotika, insbesondere Moxifloxacin, im Rahmen eines Infektes der oberen Atemwege zu sein, aber auch spontan auftretende Fälle sind beschrieben. Betroffen sind v. a. Frauen mittleren Alters. Die genaue Ursache des BAIT-Syndroms ist bisher unklar. Diskutiert wird ein möglicher Einfluss der Konzentration des Antibiotikums im Glaskörper. Differenzialdiagnostisch muss bei Iristransilluminationsdefekten insbesondere auch an Albinismus, intraokuläre Entzündungen, Pseudoexfoliationssyndrom und Pigmentdispersionssyndrom gedacht werden. Eine spezifische Therapie des BAIT-Syndroms besteht bisher nicht. Erhöhte Lichtempfindlichkeit und ein Post-BAIT-Glaukom können mögliche Komplikationen sein. Die Kenntnis des seltenen BAIT-Syndroms kann im klinischen Alltag hilfreich bei der differenzialdiagnostischen Einordnung einer Anisokorie sein und ggf. zur Vermeidung unnötiger diagnostischer Schritte beitragen.
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Affiliation(s)
- Jan Klonner
- Universitäts-Augenklinik, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Daniel Salchow
- Universitäts-Augenklinik, Leitung der Sektion Kinderaugenheilkunde, Strabologie/Orthoptik, Neuroophthalmologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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22
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Yagci BA, Atas F, Kaya M, Arikan G. COVID-19 Associated Bilateral Acute Iris Transillumination. Ocul Immunol Inflamm 2021; 29:719-721. [PMID: 34124990 DOI: 10.1080/09273948.2021.1933073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Purpose: To report a case of bilateral acute iris transillumination (BAIT) in association with coronavirus disease 2019 (COVID-19).Case report: A 44-year-old woman patient presented with decreased visual acuity, pain, photophobia, and redness in both eyes. The patient reported that she had recent close contact with severe acute respiratory syndrome - coronavirus-2 (SARS-CoV-2) case; also, she mentioned that she was hospitalized for bilateral pneumonia for 14 days. On examination, visual acuity of both eyes was 20/40. Slit-lamp biomicroscopy showed bilateral pigment deposition on the corneal endothelium, 4+ pigment dispersion in the anterior chamber, iris depigmentation with iris transillumination defects. Intraocular pressure was measured as 32 mmHg in right eye and 38 mmHg in left eye. The patient was started on bilaterally topical anti-inflammatory and anti-glaucomatous therapy.Conclusion: It is important to keep in mind that ocular manifestations associated with COVID-19 may include rare entities such as BAIT.
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Affiliation(s)
- Betul Akbulut Yagci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ferdane Atas
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mahmut Kaya
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gul Arikan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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23
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Toxic Anterior Segment Syndrome with Intracameral Moxifloxacin: Case Report and Review of the Literature. Case Rep Ophthalmol Med 2021; 2021:5526097. [PMID: 33747588 PMCID: PMC7943300 DOI: 10.1155/2021/5526097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
A case of severe anterior segment toxicity secondary to high-volume, undiluted intracameral moxifloxacin for endophthalmitis prophylaxis is reported. We examine the other reported cases of toxicity after intracameral moxifloxacin, as well as iris depigmentation and transillumination syndromes after oral and topical fluoroquinolone exposure. Additionally, we review the literature on safety, efficacy, and appropriate dosing of intracameral antibiotics with a focus on moxifloxacin.
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24
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Papasavvas I, LeHoang P, Herbort CP. Two Rare Causes of Anterior Pseudo-Uveitis Affecting the Iris: Sequelae of Bilateral Acute Iris Transillumination (BAIT) Syndrome and Iridocorneal Endothelial (ICE) Syndrome. Klin Monbl Augenheilkd 2021; 238:443-447. [PMID: 33607683 DOI: 10.1055/a-1354-6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne
| | - Phuc LeHoang
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, Sorbonne University, Paris, France & Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne
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25
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Chee SP, Win MZA. Iris Manifestations in Inadequately Treated Chronic Recurrent Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2021; 30:1116-1122. [PMID: 33561370 DOI: 10.1080/09273948.2020.1870701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To describe the iris changes in chronic recurrent Vogt-Koyanagi-Harada Disease (VKH)Methods: Retrospective case series. Clinical features of 3 VKH patients who developed bilateral depigmentation of the iris are described.Results: Patients had delayed diagnosis and inadequately treated chronic recurrent VKH. Patient 1 presented with bilateral multiple contiguous small granulomatous iris stromal lesions, severe diffuse iris swelling more severe near the iris root, producing peripheral iris undulations. Diffuse iris atrophy and peripheral depigmentation subsequently developed. Patient 2 presented with peripheral iris depigmentation, atrophy of the ciliary zone iris stroma and sparing of the sphincter pupillae, giving a 'sunflower appearance.' Patient 3 had extensive iris depigmentation, atrophy, and transillumination defects involving the entire iris.Conclusion: Uncontrolled bilateral diffuse granulomatous stromal iris inflammation leads to subsequent depigmentation, transillumination defects and atrophy, beginning in the peripheral iris. Sphincter pupillae is initially spared but complete iris atrophy may develop.
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Affiliation(s)
- Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cataract Group, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, 8 College Rd, Singapore, Singapore
| | - May Zun Aung Win
- Department of Ophthalmology, University of Medicine 1, Yangon, Myanmar.,Uveitis Service, Yangon Eye Hospital, Yangon, Myanmar
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Wey S, Flamendorf J, Sinha S, Lee D. Surgical Management of Glaucoma Secondary to Bilateral Acute Iris Transillumination: A Role for Gonioscopy-assisted Transluminal Trabeculotomy. J Ophthalmic Vis Res 2021; 16:122-126. [PMID: 33520135 PMCID: PMC7841269 DOI: 10.18502/jovr.v16i1.8258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/16/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose We report a case of bilateral acute iris transillumination (BAIT) in a young woman associated with ocular hypertension which eventually progressed to glaucoma that was treated with gonioscopy-assisted transluminal trabeculectomy (GATT). Case Report A 37-year-old otherwise healthy female presented with intermittently red and inflamed eyes and blurred vision. She was treated with oral moxifloxacin months prior to presentation. Iris transillumination defects, a pigmented anterior chamber reaction, the absence of keratic precipitates, and a history of upper respiratory infection treated with an oral fluoroquinolone prompted the diagnosis of BAIT. Intraocular pressure (IOP) remained uncontrolled on multiple glaucoma medications. Following the development of new visual field defects, indicating progression to glaucoma, GATT with cataract extraction was performed. Conclusion Although surgical intervention is rare with BAIT, our case demonstrates that GATT may be used effectively in those patients needing better IOP control before considering incisional glaucoma surgery.
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Affiliation(s)
- Stephanie Wey
- Department of Ophthalmology, University of Cincinnati, OH, USA
| | | | - Sapna Sinha
- Glaucoma Service, Wills Eye Hospital, PA, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, PA, USA
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Muñoz-Ortiz J, Reyes-Guanes J, de-la-Torre A. Reply: Anterior Uveitis Due to Intracameral Moxifloxacin: A Case Report. Ocul Immunol Inflamm 2020; 30:520-521. [PMID: 32976052 DOI: 10.1080/09273948.2020.1805986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Juliana Muñoz-Ortiz
- Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Peñaranda-Henao M, Reyes-Guanes J, Muñoz-Ortiz J, Gutiérrez ÁM, De-La-Torre A. Anterior Uveitis Due to Intracameral Moxifloxacin: A Case Report. Ocul Immunol Inflamm 2020; 29:1366-1369. [DOI: 10.1080/09273948.2020.1757120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Juliana Reyes-Guanes
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Escuela Superior De Oftalmología, Instituto Barraquer De América, Bogotá, Colombia
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | | | - Alejandra De-La-Torre
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
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